specimen management. at the end of this module, you will be able to: describe the importance of...
TRANSCRIPT
DR.KHODAVERDIAN
Specimen Management
OBJECTIVESAt the end of this module, you will be
able to: Describe the importance of specimen
management. Define the specimen management
process for receipt, rejection, identification, transport, storage, inventory and disposal.
Identify policies and procedures needed to support specimen management.
Purchasing &
Inventory
Assessment
Occurrence
Management
Information
Management
Process Improveme
nt
Customer Service
Facilities & Safety
A SYSTEMS APPROACH TO LABORATORY QUALITY
Organization
Personnel
Equipment
Documents &
Records
Process Control (QC &
EQA) & Specimen
Management
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The result of any laboratory examination is only as good as the sample received in the laboratory
IMPORTANCE OF SPECIMEN MANAGEMENT
Why is specimen management important?
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Influences laboratory efficiency
Directly affects
patient care and outcome
Influences therapeutic
decisions
Essential to accurate
laboratory diagnosis
Good sample
management
Goodsample
management
Impacts patient length of stay, hospital costs, and laboratory costs
SPECIMEN MANAGEMENT MEANS…
Policies, procedures and infrastructure to support
the safe handling and treatment of biological
specimens
PITFALLS Saying “Yes” to everything
Accepting every specimen
Afraid to say “No” to physicians Someone with sufficient authority MUST
support laboratory policy Good lab practice – Patients first!
Having no boundaries for technical issues
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COMPONENTS
Information needed
Transport
Retention, storage, disposal
Assessing, processing,
tracking
Labeling
Collection, preservation
LaboratoryHandbook
Policies & Practices
TEST REQUISITION
Patient identification Clinical data, where indicated Contact info for requesting physician or
authorized individual Tests requested Time and date of specimen collection Source of specimen, when appropriate
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Define a good labeling systemAssess all samples -
preexamination
Provide sample collection information
What- When- How
The Laboratory’s Responsibilities
Provide appropriate containers and supplies
OUTCOMES OF IMPROPER COLLECTION Delays in getting test results Unnecessary re-draws/re-tests Decreased customer satisfaction Increased costs Incorrect diagnosis / treatment Injury Death
SPECIMEN COLLECTION PROCEDURES Should include instructions for:
Positively identifying the patient before collecting a specimen
Required specimen for each requested test Preparation of patient Type of collection container, required
volume, timing Preservation of specimen, e.g., transport
media Proper specimen labeling Special handling instructions, e.g.,
refrigeration
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COLLECTION REQUIREMENTS patient preparation patient identification type of sample required type of container needed labeling special handling safety precautions
وريدی خون نمونه آوری جمع
بيمار 1. مشخصات با آزمايش درخواست برگه مشخصات انطباق
گيري 2. نمونه از پيش غذايي رژيم ازرعايت اطمينان
نياز 3. مورد وسايل انتخاب
دستکش 4. از استفاده
.5) ( الکتات تورنيکه بستن
مناسب 6. وريد انتخاب
نمونه گيري 7. محل تميزكردن
گيري 8. نمونه
تورنیکه 9. کردن بازسوزن 10. سر دفعخون 11. تخلیه.12 : نمونه زمان و ،تاریخ شناسایی خانوادگی،شماره نام نام گذاری برچسب
گیر نمونه فرد نام گیری،
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LABELING
Each sample should be labeled with:-patient’s name-patient’s unique ID number -test ordered-time and date of collection-collector’s initials
Use computer-generated bar codes when possible
ها نکته نمونه بدنبال زمان کوتاهترين در بايد پالسما يا سرم
گردد جدا خوني هاي سلول از زمان. گيري حداکثرپالسما يا سرم جداسازي جهت پس ساعت 2 مجاز
(. گردد مي پيشنهاد گيري نمونه در 15-10از دقیقه1000 -1200g)
: عمل از قبل تا بايد ها نمونه بعضي نمودن سردشوند داري نگه سرما در جداسازي
پوش در وجود لوله وضعیتزمانهمولیز نور به مجاورت
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مناسب : نواحی ( سوم دست انگشتان انتهایی بند
) چهارم یاپا پاشنه وخارجی داخلی سطح
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SAMPLE TRACKING-MANUAL confirm receipt of samples, include date and time label samples appropriately; keep with the test
requisition until laboratory ID is assigned track aliquots–traceable to the original sample
SPECIMEN REJECTION CRITERIA:
Unlabeled specimen Insufficient patient information Hemolyzed specimen Wrong tube drawn Wrong specimen submitted Inadequate volume for the amount of
preservative Insufficient quantity Prolonged transport
SPECIMEN HANDLING
Handle all specimens as if infectious Use tracking system for all specimens:
Accession / logging process Confirm actual receipt of specimens Date and time of specimen receipt Track aliquots – traceable to the original
sample
SPECIMEN HANDLING
Establish procedures for handling: Stat / urgent requests Delayed testing, e.g., storage, separation
of serum/plasma from cells Leaking containers Contaminated forms Preservation of specimens
SPECIMEN TRANSPORT
Train personnel in appropriate safety and packaging procedures
Package and preserve specimens appropriately
Transport specimens at appropriate temperature
Determine acceptable transport time Determine mode of transport
Courier, ambulance, clinic/lab staff Adhere to the International Air Transport
Association (IATA) regulations
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SAMPLE TRANSPORT
Maintain integrity of sample: temperature preservation of sample special transport containers time limitations
Assure safety regulationsare met
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Transport Regulations
Where do they come from?
Who develops them?
National transport regulations ICAO/IATA transport regulations (air)
rail, road, and sea traffic agencies postal services private couriers
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SAMPLE STORAGE-WRITTEN POLICY
describe samples to be stored determine retention time determine location describe proper conditions establish method of
organizing samples
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SAMPLE RETENTION
set policy for retention monitor stored samples,
including freeze/thaw cycles
maintain an organized, accessible system
establish a schedule to review all stored samples
establish tracking procedures
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SAMPLE REFERRAL Record:
samples referred date of referral name of person referring test
Monitor / Track, and Record: turnaround time results delivery (from referral laboratory,
to requestor) problems with referral
بالينی های نمونه ارجاع دستورالعمل
ارجاع آزمايشگاه انتخاب معيارهایخدمات - کيفيت
نمونه، - ) انتقال شيوه ها، آزمايش دامنه خدمات ارايه کارايی) ارتباطی ،سيستم نتايج تفسير کاری،نحوه چرخه زمان
بخشی - اثر هزينه
قرارداد عقد آزمايشگاهی های نمونه وانتقال بندی بسته دهنده ارجاع آزمايشگاه الزامات ارجاع آزمايشگاه الزامات
SPECIMEN DISPOSAL
Develop policy for disposal of medical waste Establish and follow disinfection procedures Comply with local regulations Include policy of disposal of rejected specimens
Appoint someone with oversight responsibilities
Establish a schedule to review all stored specimens
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KEY MESSAGES
laboratory must have good samples in order to ensure accuracy and reliability of testing and confidence in results
Sample management directly affects patient care and outcome
مايعات
نوع نمونهظروف وملزومات
مورد نيازآماده سازی بيمار راهنمايی خاص
شرايط انتقال به آزمايشگاه
شرايط نگه داری تا قبل از انجام
آزمايش
محيط های کشت اوليه مورد نياز
تهيه گسترش مستقيم
توضيحات
مايع مغزی نخاعیلوله در پيچ دار
استريلضد عفونی کردن
پوست قبل ازآسپيراسيون نمونه
فوری-دمای اتاق ساعت در دمای 6 درجه –جهت 37
شناسايی ويروس ها روزدر 3نمونه تا
درجه قابل 4دمای نگه داری است
BA-CA گرم محيط تايو جهت تهيه شده از CSFتمونه
شانت استفاده شود.
گوشداخلی لوله در پيچ دار
استريل يا حاوی محيط انتقالی غير
هوازی
تميز نمودن کانال گوش با محلول
صابونی ماليم قبل از سوراخ نمودن پرده
آسپيره نمودن ترشحات پشت پرده گوش-در
صورت پاره بودن پرده جمع آوری ترشحات به
کمک سواپ
فوری-دمای اتاق ساعت در دمای 6اتاق
BA-CA-MACقبل از درمان
استفاده از محيط تايو
گرم استفاده از محيط بی هوازی جهت
نمونه های تيمپانو سنتزيس
خارجی سواپ مرطوب شده با محيط استوات يا
آميس
پوسته ها به کمک سالين استريل پاک
گردد
سواپ داخل مجرای گوش محکم چرخانده شود
ساعت2 4تادمای اتاق
ساعت24تا دمای اتاق
BA-CA-MAC گرم
چشمملتحمه سواپ مرطوب شده
با محيط استوات يا آميس
نمونه گيری از هر دو چشم-استفاده از سواپ مرطوب شده با سالين
استريل
ساعت2 4تادمای اتاق
ساعت24تا دمای اتاق
BA-CA-MAC گرم ،آکريدين نارنجي رنگ آميزی های
هيستولوژيک(نظير گيمسا)
QUESTION